WHAT CAN OTHER DEMENTIA CARE SETTINGS LEARN FROM GREEN CARE FARMS? AN EXPLORATION OF THEIR FUNCTIONS AND FORMS

Abstract Green Care Farms (GCFs) are an innovative long-term care alternative in dementia. They aim to better meet residents’ needs by integrating nature and animals into daily life. This study explores the functions of GCFs and possible forms of realizing them in practice. A multiple case study using ethnographic methodology was conducted on two sites: one original GCF established for seven years and one regular nursing home redesigned and recently opened aiming to apply GCF characteristics. Participatory observations (n=58), interviews (n=64), a focus group, an environmental assessment and expert panels were conducted. Six functions of GCFs were identified, crucial for the successful execution of their innovative vision in practice: providing opportunities for purposeful activities, stimulating residents, creating a community, sharing responsibilities, integrating the vision in all actions and continuously transforming. These functions may take several forms, which could be implemented in regular care, taking into account the specific local context.

of Public Health, Baltimore, Maryland, United States, 2. University of Madison,Wisconsin,United States,3. Johns Hopkins,Baltimore,Maryland,United States,4. Johns Hopkins University,Baltimore,Maryland,United States,5. Columbia University Irving Medical Center,New York City,New York,United States Estimates range from 2-8% of dementia cases in the US are attributable to hearing loss.Here, we investigate measurement considerations in quantifying the population attributable fraction (PAF) of dementia from hearing loss to highlight how differences in methodology can underestimate the PAF.We use two cohort studies of older adults in the US: the National Health and Aging Trends Study (NHATS), a nationally-representative sample of older Medicare beneficiaries; and the Atherosclerosis Risk in Communities (ARIC) Study, a large, community-based cohort study with longitudinal follow-up.Each study collects reference-standard hearing measures on participants.We have two specific aims.First, we compare two valid, formula-based approaches to quantifying the PAF.The advantages of quantifying a PAF using a well-characterized, biracial, community-based sample with a longitudinal design are weighed against those of using a nationally-representative sample with a cross-sectional design (moderate or greater hearing loss: PAF in NHATS, 16.9% [95% CI: 4.1-28.7%];PAF in ARIC, 13.2% [95% CI: 2.2-20.9%]),highlighting the need for longitudinal designs in studies of the PAF from hearing loss.Second, we describe the impact of subjective versus objective measures of hearing loss on the PAF.In ARIC, subjective hearing loss was not associated with incident dementia (hazard ratio <1.0).PAFs of dementia from objective hearing loss were 6-to 8-fold greater than PAFs previously quantified using self-reported hearing measures in population-based studies.Our findings have broad implications for the inclusion of hearing loss as a potentially modifiable risk factor in clinical and public health initiative for dementia prevention.

DEMENTIA-FRIENDLY ENVIRONMENTS IN THE COMMUNITY -AN INTERNATIONAL PERSPECTIVE ON CONCEPTS AND INTERVENTIONS
Chair: Karin Wolf-Ostermann Co-Chair: Hilde Verbeek Discussant: Marie Boltz Dementia is one of the major age-related societal challenges and causes enormous demands for persons living with dementia (PlwD).Although dementia is one of the major reasons for relocation into a nursing home, most PlwD want to live as long as possible in a familiar domesticity.Therefore, innovative care concepts for community-dwelling PlwD are being developed worldwide as alternative to traditional long-term care settings.Efforts are made to learn more about dementia-friendly environments in order to improve quality of care and quality of life of PlwD.This international symposium will therefore provide four presentations as well as a concluding discussion addressing new concepts for innovative care environments and measuring dementia-friendliness of the built environment as well as nonpharmacological interventions to support high quality person-centred care.The first presentation explores the functions of 24-hour green care farms as alternative to nursing homes and how these can be transferred to other care settings.The second presentation discusses the impact of moving from traditional care environments to innovative care settings for residents and staff.The third presentation presents results of a cluster randomized controlled trial in German shared housing arrangements where a complex nonpharmacological intervention led to significantly less hospital admissions for PlwD.And the final presentation describes an innovative approach to evaluate the wayfinding infrastructure in urban areas for PlwD and to promote dementia-friendliness in urban living structures.The discussant will synthesize the research findings and lead a discussion of research implications and future directions for policy and practice.

REDUCING HOSPITAL ADMISSIONS FOR PEOPLE LIVING WITH DEMENTIA-RESULTS FROM THE GERMAN DEMWG-STUDY
Karin Wolf-Ostermann 1 , Annika Schmidt 1 , Susanne Stiefler 1 , Janissa Altona 1 , Andre Kratzer 2 , Carolin Donath 2 , and Elmar Graessel 3 , 1. University of Bremen, Bremen, Bremen, Germany, 2. Universitätsklinikum Erlangen, Erlangen, Bayern, Germany, 3. Psychiatrische Universitaetsklinik Erlangen, Erlangen, Bayern, Germany People living with dementia (PlwD) have a high risk of being admitted to hospital, especially in advanced stages of dementia -with often severe negative consequences.The DemWG-study therefore aimed to reduce the number of hospital admissions for long-term care dependent PlwD by a complex intervention -including motor and cognitive training for PlwD and education of caregivers and general practitioners.By means of a cluster randomised longitudinal design, data on hospital admissions as well as quality of life, risk of falls, challenging behaviours and cognitive functioning were assessed in 97 shared-housing arrangement (SHA) in Germany with a total of 341 PlwD at baseline and after a 6 months intervention.Results of the of longitudinal data analysis showed a significant decline in hospital admissions for the intervention period and less challenging behaviours.Quantitative and additionally qualitative data were also collected 12 and 18 months after baseline.Caregivers perceived improved social interaction, which in turn has a positive effect on living together in the SHA.Based on the results and in light of the urgent need for easy to implement non-pharmacological and/or psychosocial therapy approaches recommendations for better care and support can be derived and the intervention can be implemented in everyday practice.
forms of realizing them in practice.A multiple case study using ethnographic methodology was conducted on two sites: one original GCF established for seven years and one regular nursing home redesigned and recently opened aiming to apply GCF characteristics.Participatory observations (n=58), interviews (n=64), a focus group, an environmental assessment and expert panels were conducted.Six functions of GCFs were identified, crucial for the successful execution of their innovative vision in practice: providing opportunities for purposeful activities, stimulating residents, creating a community, sharing responsibilities, integrating the vision in all actions and continuously transforming.These functions may take several forms, which could be implemented in regular care, taking into account the specific local context.

EXPERIENCES OF STAFF MEMBERS RELOCATING FROM A NURSING HOME TO AN INNOVATIVE LIVING ARRANGEMENT FOR OLDER ADULTS
Mara Brouwers 1 , Bram Boer 2 , Wim Groen 3 , and Hilde Verbeek 2 , 1. Maastricht university, Maastricht, Limburg, Netherlands, 2. Maastricht University, Maastricht, Limburg, Netherlands, 3. Amsterdam UMC, Amsterdam, Noord-Holland, Netherlands More innovative living arrangements are developed within long-term care, leading to an increase in relocations.Relocating within long-term care is a long pending and intensive undertaking, especially for staff members.The combination of relocating and achieving a successful culture change might be a daunting task for staff members.Given the increase in the number of relocations and the fast development of innovative living arrangements, it is key to expand our knowledge concerning the impact such an undertaking has.The research question is therefore: 'How is the relocation from a regular to an innovative living arrangement experienced by staff members?' To answer this research question, 41 semistructured interviews with staff members of several nursing homes undergoing a relocation were conducted.These nursing homes had to undergo a relocation to an innovative living arrangement.Findings indicate that a relocation process within long-term care is an intensive and stressful undertaking.Staff members often describe the relocation process as 'stressful', 'chaotic', and 'intense'.Furthermore, although staff members are mostly positive about the new physical environment, they experience an array of barriers when trying to implement a new way of working.They define two key elements for successfully relocating and implementing a new way of working.First, clear communication and receiving sufficient information throughout the relocation process.Second, proper preparation for implementing a new way of working and coaching on the job.It is evident that relocating to an innovative living arrangement is a large undertaking that requires careful planning.

EVALUATING WAYFINDING INFRASTRUCTURES FOR PEOPLE LIVING WITH DEMENTIA-THE 360 DEGREE MAPS STUDY DENHB
Janissa Altona 1 , Henrik Wiegelmann 2 , Emily Mena 2 , Julia Misonow 2 , Benjamin Schuez 2 , and Karin Wolf-Ostermann 2 , 1. University of Bremen, Institute of Public Health and Nursing Research,Bremen,Bremen,Germany,2. University of Bremen,Bremen,Bremen,Germany Recent studies point to the importance of the built environment for the cognitive and social health of communitydwelling people living with dementia.One key aspect is wayfinding infrastructure, especially in urban areas.However, currently there are no clear indicators of wayfaring infrastructure and no standardized assessment instruments.Here, we provide such an instrument with the potential for online digital assessment as the result of the German DenHB-study.Based on an umbrella review and further research, we first developed a questionnaire to evaluate local wayfinding structures which are sectioned in different thematic blocks like general streetscape, signage, public transportation, buildings etc.Second, we conducted a cross-sectional validation study in the urban area of Bremen, Germany using Apple Maps Street View (2022) with a 360-degree viewing angle at more than 3,000 randomly selected geo coordinates within urban districts with a high proportion of older residents (>65 years).The results document supportive as well as inhibiting wayfinding structures from the perspective of people living with dementia and can also form a basis for a later automated digital evaluation of wayfinding structures.Hence, providing easy to obtain new insights helps to support the development of actions to promote the dementia-friendliness of urban living structures.

LONG-TERM CARE AND WORKFORCE
Abstract citation ID: igad104.0771

ASSESSING STAFF PERCEPTIONS OF WORKPLACE SAFETY IN NURSING HOMES: ITEM SET DEVELOPMENT AND TESTING
Katarzyna Zebrak 1 , Naomi Yount 1 , Joann Sorra 2 , Laura Gray 1 , Jessica Kirchner 1 , and Joanne Campione 3 , 1. Westat,Rockville,Maryland,United States,2. Westat,Westat,Maryland,United States,3. Westat,Durham,North Carolina,United States Workplace safety is important for advancing resident safety and eliminating harm to both nursing home staff and residents.The goal of this study was to develop and test survey items to assess how the organizational culture in nursing homes supports workplace safety for staff.After conducting a literature review and background interviews with nursing home staff and workplace safety experts, we identified important areas of workplace safety culture (i.e., workplace hazards; moving/transferring/lifting residents; inappropriate resident behavior toward staff; interactions among staff; supervisor/management support for workplace safety; workplace safety reporting; and, work stress/ burnout) and drafted survey items to assess each area.These draft items were administered with the AHRQ Surveys on Patient Safety Culture (SOPS) Nursing Home Survey to staff in 48 U.S. nursing homes.We conducted psychometric analysis on data from 2,468 respondents.Confirmatory factor analysis results and internal consistency and site-level reliability coefficients were acceptable for the 18 survey items grouped into 6 composite measures.All composite measures were significantly correlated (p< 0.05) with each other and